乙型肝炎肝硬化不同性质结节在超声造影灌注时相的增强表现特点

Contrast-enhanced ultrasound perfusion characteristics of different nodules in hepatitis B-related cirrhosis

目的分析乙型肝炎肝硬化不同性质结节在超声造影灌注时相的增强表现特点及超声造影灌注时相分析技术对不同性质结节的诊断价值。方法选择2020年3月—2023年3月南京市第二医院收治的107例乙型肝炎肝硬化患者(结节数量183枚),患者均接受穿刺活检和超声造影检查,比较不同性质结节超声造影特征,记录不同灌注时相局部血流量(RBF)、局部血容量(RBV),以病理检查结果为金标准,分析超声造影诊断不同性质结节与金标准的一致性。结果增生结节三期增强扫描主要表现为等回声-等回声-等回声的增强方式,不典型增生结节主要表现为高回声或低回声-等回声-等回声的增强方式,微小肝细胞癌主要表现为高回声-等回声-等回声或低回声的增强方式,其超声造影特征比较差异有统计学意义(P<0.05);增生结节三期增强扫描的RBF分别为(38.95±13.73)、(104.82±31.59)、(42.93±11.39)mL/s,RBV分别为(1281.46±422.08)、(1347.25±416.98)、(729.61±218.36)mL,不典型增生结节三期增强扫描的RBF分别为(42.92±12.36)、(27.26±6.52)、(25.17±7.36)mL/s,RBV分别为(1498.63±472.56)、(1984.63±315.09)、(603.94±96.83)mL,微小肝细胞癌三期增强扫描的RBF分别为(63.19±10.58)、(28.33±5.96)、(18.24±5.13)mL/s,RBV分别为(3385.26±517.94)、(1205.94±256.37)、(372.19±74.35)mL,差异均有统计学意义(P<0.05);病理检查结果显示,193个结节中增生结节128个、不典型增生结节16个、微小肝细胞癌39个,超声造影检查显示,183个结节中增生结节120个、不典型增生结节25个、微小肝细胞癌38个,超声造影诊断增生结节的灵敏度为0.922、特异度为0.964、准确率为0.934,Kappa值为0.850,诊断不典型增生结节的灵敏度为0.750、特异度为0.922、准确率为0.907,Kappa值为0.536,诊断微小肝细胞癌的灵敏度为0.846、特异度为0.965、准确率为0.940,Kappa值为0.819。结论经超声造影灌注时相分析,乙型肝炎肝硬化背景下增生结节、不典型增生结节、微小肝细胞癌的增强方式存在一定差异,且不同灌注时相的RBF、RBV也存在差异,采用超声造影诊断不同性质结节、预防微小肝细胞癌具有较好的价值。

Objective To analyze the features of different nodules in hepatitis B-related cirrhosis during the contrast-enhanced ultrasound perfusion(CEUS)phase and assess the diagnostic value of CEUS phase analysis technology for these nodules.Methods Pathological examination identified 128 hyperplastic nodules,16 atypical hyperplastic nodules,and 39 minimal hepatocellular carcinoma(HCC)out of 193 nodules.Ultrasound contrast examination showed 120 hyperplastic nodules,25 atypical hyperplastic nodules,and 38 minimal HCC out of 183 nodules.Results Three phase enhanced scanning of hyperplastic nodules are mainly manifested as isoechoic-isoechoic-isoechoic enhancement.Atypical hyperplastic nodules mainly exhibited hyperechoic or hypoechoic-isoechoic-isoechoic enhancement.Small HCC is mainly manifested as hyperechoic-isoechoic or hypoechoic enhancement,with these contrast-enhanced ultrasound features being statistically significant(P<0.05).The RBF(regional blood flow)in the three-phase enhanced scanning of hyperplastic nodules were(38.95±13.73)mL/s,(104.82±31.59)mL/s,and(42.93±11.39)mL/s,respectively.The RBV(regional blood flow)were(1281.46±422.08)mL,(1347.25±416.98)mL,and(729.61±218.36)mL,respectively.For atypical hyperplastic nodules,the RBF values were(42.92±12.36)mL/s,(27.26±6.52)mL/s,and(25.17±7.36)mL/s,with RBV values of(1498.63±472.56)mL,(1984.63±315.09)mL,and(603.94±96.83)mL,respectively.For small HCC,the RBF values were(63.19±10.58)mL/s,(28.33±5.96)mL/s,and(18.24±5.13)mL/s,respectively,with RBV values of(3385.26±517.94)mL,(1205.94±256.37)mL,and(372.19±74.35)mL,respectively,showing statistical significance(P<0.05).Pathological examination showed 128 hyperplastic nodules,16 atypical hyperplastic nodules,and 39 minimal HCC out of 193 nodules.Ultrasound contrast-enhanced examination showed 120 hyperplastic nodules,25 atypical hyperplastic nodules,and 38 minimal HCC out of 183 nodules.The sensitivity,specificity,accuracy,and Kappa value of contrast-enhanced ultrasound for diagnosing hyperplastic nodules were 0.922,0.964,0.934,and 0.850,respectively.For diagnosing atypical hyperplastic nodules,the sensitivity was 0.750,specificity was 0.922,accuracy was 0.907,and the Kappa value was 0.536.For diagnosing small hepatocellular carcinoma,the sensitivity was 0.846,specificity was 0.965,accuracy was 0.940,and the Kappa value was 0.819.Conclusion The analysis of the CEUS shows different enhancement modes for hyperplastic nodules,atypical hyperplastic nodules,and micro HCC in the context of hepatitis B-related cirrhosis.The RBF and RBV values also vary across different perfusion phases.CEUS demonstrates significant value in diagnosing nodules of different natures and and in the early detection of micro HCC.